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WALGREEN CO.
DSH050195 WASHINGTON HOSPITAL HEALTHCARE SYSTEM
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Covered Entity Details
Entity Name
WASHINGTON HOSPITAL HEALTHCARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050195
Entity Address
2000 MOWRY AVENUE
FREMONT, CA 94538
Medicare Provider Number
050195
Participating Start Date
7/1/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21193
1757 W SAN CARLOS ST
SAN JOSE, CA 95128
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry LaBossiere, SVP & COO
(510) 818-6586
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/15/2025
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